The International Osteoporosis Foundation (IOF) has advised physicians to make treatment decisions more individualized for patients taking bisphosphonates; a class of drugs used to treat osteoporosis.

The long-term use of bisphosphonates has been linked to rare cases of atypical femoral fractures (AFF) and osteonecrosis of the jaw (ONJ), leading some clinicians to prescribe a bisphosphonate ‘holiday' without taking into account the patient's risk of fracture.

The call to physicians to re-evaluate the discontinuation of bisphosphonate treatment comes in a new IOF Working Group editorial. The group cites a number of prominent concerns over stropping treatment as reasons to follow a more individual approach. These include the prevalence of stopping treatment in cases where patients are at high risk of fracture, and in instances where bone density gains can be rapidly lost. Drug holidays may also impact future osteoporosis treatment adherence, which is already considered to be low.

“We want to remind physicians and patients alike that while the incidence of AFF and ONJ are very rare, hip and spinal fractures in high risk patients are, in contrast, far more common and a major cause of disability, loss of quality of life and early death,” said lead author Stuart Silverman, Ceders-Sinai Medical Center and Professor of Medicine, UCLA. The authors acknowledged that more research is needed so physicians can be provided with clear recommendations.